Healthcare Provider Details

I. General information

NPI: 1003201716
Provider Name (Legal Business Name): SOFIA GABRILOVICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-6673
  • Fax:
Mailing address:
  • Phone: 414-805-0505
  • Fax: 414-805-6805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number84326-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: